From the Guidelines
Treatment for gangrene requires immediate medical attention and typically involves a combination of approaches, including surgical debridement, antibiotics, and addressing the underlying cause, with the primary goal of reducing morbidity, mortality, and improving quality of life. The primary treatments include surgical debridement to remove dead tissue, antibiotics to fight infection, and addressing the underlying cause. For wet gangrene, broad-spectrum antibiotics like piperacillin-tazobactam, meropenem, or combinations including metronidazole are administered intravenously until cultures identify specific pathogens 1.
Key Treatment Components
- Surgical debridement to remove dead tissue, which should be performed as soon as possible in the presence of high suspicion for Fournier’s gangrene 1
- Antibiotics to fight infection, with initial coverage being broad, including for gram-positive, gram-negative, aerobic and anaerobic organisms, and an anti-methicillin-resistant S. aureus (MRSA) agent 1
- Addressing the underlying cause, which may include revascularization procedures such as bypass surgery or angioplasty if poor blood flow caused the gangrene
Surgical Approach
- Early and aggressive surgical debridement improves survival and reduces the number of surgical revisions 1
- A multidisciplinary and tailored approach based upon the extent of perineal involvement, the degree of fecal contamination, and the possible presence of sphincter or urethral damage is recommended 1
Antibiotic Regimen
- Empiric antimicrobial therapy should be started as soon as the diagnosis is suspected, with coverage for gram-positive, gram-negative, aerobic and anaerobic bacteria, and an anti-MRSA agent 1
- Microbiological samples should be obtained at the index operation to tailor specific antibiotic management 1
Additional Considerations
- Hyperbaric oxygen therapy may be used as an adjunctive treatment, providing high-pressure oxygen to help kill bacteria and promote healing 1
- Proper wound care is essential, including regular dressing changes and monitoring for signs of spreading infection
- The aggressive approach to treatment is necessary because gangrene can rapidly progress, leading to sepsis and potentially death if not addressed promptly and thoroughly 1
From the Research
Treatment Options for Gangrene
The treatment for gangrene typically involves a combination of surgical, medical, and supportive therapies. Some of the key treatment options include:
- Surgical debridement to remove dead tissue and prevent the spread of infection 2, 3, 4, 5
- Antibiotic therapy to treat underlying infections 2, 3, 4, 5, 6
- Hyperbaric oxygen therapy to reduce systemic toxicity and promote healing 2, 3, 4, 5, 6
- Negative pressure wound therapy to manage wounds and promote tissue growth 4
- Supportive care, such as pain management and wound care, to promote overall recovery 2, 3, 4, 5
Importance of Early Treatment
Early recognition and treatment of gangrene are critical to reducing mortality and morbidity. Delayed treatment can lead to increased tissue damage, systemic toxicity, and poor outcomes 2, 3, 5, 6. A multifactorial approach to treatment, including surgical, medical, and supportive therapies, may significantly reduce the mortality and morbidity of this life-threatening disease 6.
Role of Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy has been shown to be an effective adjunctive treatment for gangrene, reducing systemic toxicity and promoting healing 2, 3, 4, 5. It is particularly useful in the treatment of clostridial gas gangrene, where it can help prevent further extension of the infection and improve overall outcomes 3, 5.